1. Addiction & the Brain

3. Communication in the Brain
 Human behaviour and emotions are controlled by
neurotransmitters that act as “keys” between
neurons.
 The amount of any given neurotransmitter in the
brain’s circuits is precisely controlled by feedback
mechanisms – like the way that a thermostat
controls temperature.

4.  Drugs are substances that disturb this delicate
balance, because they have “passkeys”
(chemicals) that let them open certain “locks”
(receptors) located between the neurons.
 The brain automatically adjusts to these
substances from outside the body by producing
fewer of its own natural “keys”.

5.  It thereby achieves a new state of ‘balance’ that
is maintained until the body starts to miss the
external substance.
 At that point, the person experiences a craving
that will persist until the neurons that stopped
producing get back to work.
 There are over 100 identified neurotransmitters,
and evidence suggests there are substantially
more.

6. We know that despite
their many differences,
most abused substances affect the
dopamine and serotonin pathways

7.  This reward circuit that is overstimulated by
drugs uses a particular neurotransmitter called
dopamine.
 It is not surprising then to discover that
practically all of the drugs that cause
dependencies affect the amount of dopamine in
the reward circuit.

8. Circuits Involved in Addiction

9. 04/09/20139

10. 04/09/201310

11. How do drugs affect the brain?
 Some substances imitate natural
neurotransmitters and take their place on their
receptors.
 Morphine, for example, binds to the receptors
for endorphin (a natural "morphine" produced
by the brain).

12.  Other substances increase the secretion of
natural neurotransmitters. Cocaine, for
example, mainly increases the amount of
dopamine in the synapses, while ecstasy mainly
increases the amount of serotonin.
 Still other substances block a natural
neurotransmitter. Alcohol, for example, blocks
the NMDA receptors.

13.  Dopamine is involved in many functions that are
essential for survival such as attentiveness,
motivation, learning, and memorization.
 Most of all, dopamine is a key element in identifying
natural rewards. Natural stimuli such as food and
water cause us to engage in certain behaviours.
 Unconscious memorization of signs associated with
reward.
 Not all drugs affect dopamine levels in the same
way.

14.  Serotonin plays an important part in the regulation
of learning, mood, sleep, appetite and constriction
of blood vessels
 Low serotonin is connected to such psychological
problems as depression, anxiety, seasonal affective
disorder, and obsessive-compulsive disorder
 Not all drugs affect serotonin levels in the same
way.

15.  Drugs and alcohol have an enormous effect on
the brain.
 Often misdiagnosed whilst in active addiction,
and prescribed medication incorrectly as a result.
 Only once drugs and alcohol are out of the
system can accurate observation and diagnosis (if
any) be made.
Medical Intervention

16.  If misdiagnosis is suspected medication will be
altered, reduced, or stopped to evaluate the
person. Through this process it will become
evident as to whether or not medication is
necessary.
 In the initial phase of treatment it may be
necessary to use medication in order to stabilise
brain function. Once this stability has been
achieved and maintained for a period of time the
medication will be reviewed and where necessary
altered, reduced or stopped.

17.  It is vital that this is done in consultation with a
doctor, preferably a psychiatrist.
 Psychiatric medication cannot be stopped at
once, altogether – this is very dangerous.
 The necessity for, amount, and period of use of
medication is dependent on the damage caused
to the brain, and on any underlying factors that
may be present (depression, bi-polar, etc.)

18.  Anti-depressants
 Fluoxetine (Prozac; Nuzak; Lilly Fluoxetine)
 Sertraline (Zoloft; Serdep; Serlife)
 Venlafaxine (Efexor; Venlor)
 Citalopram (Cipramil; Cipralex; Lexamil)
 Aimed at stabilising Serotonin levels.

20.  Anti-psychotics
 Risperidone (Risperdal)
 Quetiapine (Seroquel; Serez)
 Olanzapine (Zyprexa)
 Aimed at stabilising Dopamine levels. Quetiapine
has a sedative effect, and has been found to
further help with anxiety.

23.  Mood stabilisers
 Lamotragine (Epitech; Lamictin)
 Valproate (Epilim; Depakote)
 Carbamazepine (Tegretol)
 Topiramate (Topamax)
 Aimed at stabilising fluctuating mood. Often used
in conjunction with anti-depressant.

24.  Anxiolytics
 Benzodiazepines (Aimed at short-term relief of
severe and disabling anxiety). Highly addictive.
 Diazepam (Valium)
 Clonazepam (Rivotril)
 Lorazepam (Ativan)
 Clobazam (Urbanol)

25. Dual diagnoses/Co-morbidity
 Addiction and coexisting psychiatric illness.
 E.g. Alcoholism and depression.
 Includes amongst others, depression, mood
disorders, social phobias, personality disorders.
 Addiction – primary; psychiatric illness –
secondary
 Psychiatric illness – primary; addiction
secondary

26.  Coexisting psychiatric illness must be treated
alongside addiction – it cannot be treated before or
after addiction treatment, and addiction cannot be
treated before or after the coexisting illness.
 Symptoms of one problem may mask or worsen the
symptoms of the other.
 If dealt with separately, and not concurrently, one
problem will inevitably trigger the other.

27.  Denial and acceptance
 Motivation for change
 Adherence to treatment and post-treatment plans
 Lifestyle, psychological and emotional health, social
abilities and interactions, spiritual life
 Compliance with medication